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  • 201.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bergmo, Trine S.
    Norwegian Centre for E-health Research, Norway.
    Bülow, Cille
    Bispebjerg University Hospital, Denmark.
    Clausen, Stine S.
    University of Copenhagen, Denmark.
    Manskow, Unn Sollid
    Norwegian Centre for E-health Research, Norway.
    Timonen, Johanna
    University of Eastern Finland, Finland.
    Jøsendal, Anette Vik
    Norwegian Centre for E-health Research, Norway.
    Nationally Shared Medication Lists-Describing Systems in the Nordic Countries2023In: Caring is Sharing – Exploiting the Value in Data for Health and Innovation / [ed] Hagglund M., Blusi M., Bonacina S., Nilsson L., Madsen I.C., Pelayo S., Moen A., Benis A., Lindskold L., Gallos P., IOS Press, 2023, Vol. 302, p. 207-211Conference paper (Refereed)
    Abstract [en]

    This paper provides an overview of shared medication lists (SMLs) in four Nordic countries (Denmark, Finland, Norway and Sweden) with a focus on the type of information the list is based on. This is a structured comparison conducted in stages using an expert group, grey papers, unpublished materials, web pages, as well as scientific papers. Denmark and Finland have implemented their solutions for an SML and Norway and Sweden are working on the implementation of their solution. Denmark and Norway have or are aiming at a list based on medication orders, while Finland and Sweden have lists based on prescriptions.

  • 202.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Implementation of a shared medication list: physicians’ views on availability, accuracy and confidentiality2014In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 36, no 5, p. 933-942Article in journal (Refereed)
    Abstract [en]

    Background Physicians, patients and others involved need to have accurate information on patients’ current drug prescriptions available, and have that information protected from unauthorized access. During the past decade, many counties in Sweden have implemented regionally shared medication lists within health care. Objective The aim of this study was to describe physicians’ views on changes in accuracy, availability and confidentiality in the transition from local medication lists to a regionally shared medication list. Setting Health care units in four different counties of Sweden after the transition from local medication lists to a regionally shared medication list. The shared medication list was an integrated part of the electronic health record system in the respective counties, but the system and implementation process varied. Methods Physicians (n = 7) with experience of transition from local medication lists to a regionally shared medication list were interviewed in a semi-structured manner. Main outcome measure: Physicians’ views on changes in information risks, focusing on accuracy, availability and confidentiality. Results The transition from local medication lists to a shared medication list increased the availability of information: from being time consuming or not possible to access from other care givers to most information being available in one place. A regionally shared medication list was perceived as having the potential to provide a greater accuracy of information, but not always: the shared medication list was perceived as more complete but with more non-current drugs. On the other hand, a shared medication list implied an increased risk of violating patient privacy, placing greater demands on IT security in order to protect the confidentiality of information. Conclusion Physicians perceived a regionally shared medication list to increase the availability of information about current prescriptions and potentially the accuracy but may decrease the confidentiality of information. To implement a shared medication list, we recommend providing clear description of responsibilities and routines for normal activities as well as back-up routines, consider IT-security and data protection early, involve patients to improve the accuracy of the list as well as to monitor and evaluate the implementation.

  • 203.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Hamqvist, Sara
    Linnaeus University, Faculty of Arts and Humanities, Department of Media and Journalism.
    Villius Zetterholm, My
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Jokela, Päivi
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Ferati, Mexhid
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Current Knowledge about Providing Drug–Drug Interaction Services for Patients: A Scoping Review2021In: Pharmacy, E-ISSN 2226-4787, Vol. 9, no 2, article id 69Article, review/survey (Refereed)
    Abstract [en]

    Drug–drug interactions (DDIs) pose a major problem to patient safety. eHealth solutions have the potential to address this problem and generally improve medication management by providing digital services for health care professionals and patients. Clinical decision support systems (CDSS) to alert physicians or pharmacists about DDIs are common, and there is an extensive body of research about CDSS for professionals. Information about DDIs is commonly requested by patients, but little is known about providing similar support to patients. The aim of this scoping review was to explore and describe current knowledge about providing digital DDI services for patients. Using a broad search strategy and an established framework for scoping reviews, 19 papers were included. The results show that although some patients want to check for DDIs themselves, there are differences between patients, in terms of demands and ability. There are numerous DDI services available, but the existence of large variations regarding service quality implies potential safety issues. The review includes suggestions about design features but also indicates a substantial knowledge gap highlighting the need for further research about how to best design and provide digital DDI to patients without risking patient safety or having other unintended consequences.

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  • 204.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kalmar County, Sweden.
    Ericson, Lisa
    Swedish eHealth Agency, Sweden.
    The use of a decision support system in Swedish pharmacies to identify potential drug-related problems: effects of a national intervention focused on reviewing elderly patients’ prescriptions2020In: Pharmacy, E-ISSN 2226-4787, Vol. 8, no 3, p. 1-20, article id 118Article in journal (Refereed)
    Abstract [en]

    In pharmacies in Sweden, a clinical decision support system called Electronic Expert Support (EES) is available to analyse patients’ prescriptions for potential drug-related problems. A nationwide intervention was performed in 2018 among all Swedish pharmacy chains to increase the use of EES among patients 75 years or older. The aim of this research was to study the use of EES in connection with the national intervention in order to describe any effects of the intervention, to understand how pharmacists use EES and to identify any barriers and facilitators for the use of EES by pharmacists for elderly patients. Data on the number and categories of EES analyses, alerts, resolved alerts and active pharmacies was provided by the Swedish eHealth Agency. The effects of the intervention were analysed using interrupted time series regression. A web-based questionnaire comprising 20 questions was sent to 1500 pharmacists randomly selected from all pharmacies in Sweden. The study shows that pharmacists use and appreciate EES and that the national intervention had a clear effect during the week of the intervention and seems to have contributed to a faster increase in pharmacists’ use of EES during the year to follow. The study also identified several issues or barriers for using EES.

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  • 205.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hoffmann, Mikael
    The NEPI Foundation, Sweden.
    Nilsson, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Challenges with Medication Management and the National Medication List in Sweden: An Interview Study from a Human, Organizational, and Technology Perspective2023In: Caring is Sharing – Exploiting the Value in Data for Health and Innovation / [ed] Hagglund M., Blusi M., Bonacina S., Nilsson L., Madsen I.C., Pelayo S., Moen A., Benis A., Lindskold L., Gallos P., IOS Press, 2023, Vol. 302, p. 287-291Conference paper (Refereed)
    Abstract [en]

    Sweden is in the process of implementing the National Medication List (NLL). The aim of this study was to explore the challenges with the medication management process, as well as expectation for NLL, from a human, organizational, and technology perspective. This study included interviews with prescribers, nurses, pharmacists, patients, and their relatives and was conducted during March to June 2020, before the implementation of NLL. Challenges were (1) feeling lost with several different medication lists, (2) spending time searching for information, (3) being frustrated at parallel information systems, (4) patients being the carriers of information, and (5) the feeling of being responsible in an indistinct process. The expectations for NLL in Sweden were high, but there were several fears.

  • 206.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Lidström, Bodil
    Swedish EHlth Agcy, Stockholm, Sweden.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Eiermann, Birgit
    Karolinska Inst ; Swedish EHlth Agcy, Stockholm, Sweden.
    Potential drug related problems detected by electronic expert support system in patients with multi-dose drug dispensing.2014In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 36, no 5, p. 943-952Article in journal (Refereed)
    Abstract [en]

    Background Drug related problems (DRPs) are frequent and cause suffering for patients and substantial costs for society. Multi-dose drug dispensing (MDDD) is a service by which patients receive their medication packed in bags with one unit for each dose occasion. The clinical decision support system (CDSS) electronic expert support (EES) analyses patients’ prescriptions in the Swedish national e-prescription repository and provides alerts if potential DRPs are detected, i.e. drug–drug interactions, duplicate therapy, drug-disease contraindications, high dose, gender warnings, geriatric, and paediatric alerts. Objective To analyse potential DRPs in patients with MDDD, detected by means of EES. Setting A register study of all electronically stored prescriptions for patients with MDDD in Sweden (n = 180,059) March 5–June 5, 2013. Method Drug use and potential DRPs detected in the study population during the 3 month study period by EES were analysed. The potential DRPs were analysed in relation to patients’ age, gender, number of drugs, and type of medication. Main outcome measure Prevalence of potential DRPs measured as EES alerts. Results The study population was on average 75.8 years of age (±17.5, range 1–110) and had 10.0 different medications (±4.7, range 1–53). EES alerted for potential DRPs in 76 % of the population with a mean of 2.2 alerts per patient (±2.4, range 0–27). The older patients received a lower number of alerts compared to younger patients despite having a higher number of drugs. The most frequent alert categories were drug–drug interactions (37 % of all alerts), duplicate therapy (30 %), and geriatric warnings for high dose or inappropriate drugs (23 %). Psycholeptics, psychoanaleptics, antithrombotic agents, anti-epileptics, renin-angiotensin system agents, and analgesics represented 71 % of all drugs involved in alerts. Conclusions EES detected potential DRPs in the majority of patients with MDDD. The number of potential DRPs was associated with the number of drugs, age, gender, and type of medication. A CDSS such as EES might be a useful tool for physicians and pharmacists to assist in the important task of monitoring patients with MDDD for potential DRPs.

  • 207.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Lidström, Bodil
    Swedish eHealth Agency.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Gustafson, Yngve
    Umeå University.
    Eiermann, Birgit
    Karolinska Institutet ; Swedish eHealth Agency.
    Potential drug-related problems detected by electronic expert support system: physicians’ views on clinical relevance2015In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 37, no 5, p. 941-948Article in journal (Refereed)
    Abstract [en]

    Background Drug-related problems cause suffering for patients and substantial costs. Multi-dose drug dispensing is a service in which patients receive their medication packed in bags with one unit for each dose occasion. The electronic expert support system (EES) is a clinical decision support system that provides alerts if potential drug-related problems are detected among a patients’ current prescriptions, including drug–drug interactions, therapy duplications, high doses, drug-disease interactions, drug gender warnings, and inappropriate drugs and doses for geriatric or pediatric patients. Objective The aim of the study was to explore physicians’ views on the clinical relevance of alerts provided by EES. Furthermore we investigated if physicians performed any changes in drug treatment following the alerts and if there were any differences in perceived relevance and performed changes between different types of alerts and drugs. Setting Two geriatric clinics and three primary care units in Sweden. Method Prescribed medications for patients (n = 254) with multi-dose drug dispensing were analyzed for potential drug-related problems using EES. For each alert, a physician assessed clinical relevance and indicated any intended action. A total of 15 physicians took part in the study. Changes in drug treatment following the alerts were later measured. The relationship between variables was analyzed using Chi square test. Main outcome measure Physicians’ perceived clinical relevance of each alert, and changes in drug treatment following the alerts. ResultsPhysicians perceived 68 % (502/740) of EES alerts as clinically relevant and 11 % of all alerts were followed by a change in drug treatment. Clinical relevance and likelihood to make changes in drug treatment was related to the alert category and substances involved in the alert. Conclusion In most patients with multi-dose drug dispensing, EES detected potential drug-related problems, with the majority of the alerts regarded as clinically relevant and some followed by measurable changes in drug treatment.

  • 208.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Mzil, Leila
    Uppsala University, Sweden.
    Eiermann, Birgit
    Karolinska Institutet, Sweden;Inera AB, Sweden.
    Discrepancies in patients' medication lists from pharmacies in Sweden: an interview study before the implementation of the Swedish National Medication List2023In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 45, p. 88-96Article in journal (Refereed)
    Abstract [en]

    Background Discrepancies in medication lists are common and can contribute to drug-related problems. This study was performed before the implementation of the National Medication List in Sweden, an intervention expected to improve the accuracy of medication lists. Aim The aim of the study was to examine the number and type of discrepancies in the medication list from pharmacies in Sweden. The secondary aim was to describe the information sources Swedish patients used as their medication lists and how confident they were with the information. Method Structured interviews were conducted with patients at 13 community pharmacies in Sweden during the period October 5, 2020, to April 16, 2021. The printed medication list was reviewed together with the patient to identify any discrepancies and missing information. Results A total of 327 patients were included in the study (response rate 51%). The printed medication list from pharmacies was the most common information source for patients to know which medications to use. Two thirds (n = 215) of the patients had at least one discrepancy among their prescriptions and 32% (n = 106) were missing at least one prescription medication. Among all prescriptions (n = 2567) 10% (n = 264) were non-current prescriptions, 9% (n = 238) were duplicates and 3% (n = 88) had the wrong dose. The proportion of prescriptions with discrepancies differed between drug-groups. Conclusion The discrepancies described in this study can have serious consequences, and results provide a baseline for studies after the implementation of the National Medication List.

  • 209.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nilsson, Anna-Lena
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Patients' views on electronic patient information leaflets2016In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 14, no 2, article id 702Article in journal (Refereed)
    Abstract [en]

    Background: Information in society and in health care is currently undergoing a transition from paper to digital formats, and the main source of information will probably be electronic in the future. Objective: To explore patients’ use and perceptions of the patient information leaflet included in the medication package, and their attitude towards a transition to an electronic version. Methods: The data was collected during October to November 2014 among individuals in South-Eastern Sweden, using a questionnaire (n=406, response rate 78%) and interviews (n=15). Results: The questionnaire showed that the majority of the respondents (52%) occasionally read the patient information leaflet, 37% always read it, and 11% never read it. Almost half of the patients (41%) were positive towards reading the patient information leaflet electronically while 32% were hesitant and 26% neutral. A majority of the patients would request to get the patient information leaflet printed at the pharmacy if it was not included in the package. There were differences in attitude related to age and gender. The interviews showed that patients had mixed views on a transition to an electronic patient information leaflet. The patients perceived several positive aspects with an electronic patient information leaflet but were concerned about elderly patients. Conclusion: Although many were positive towards reading the patient information leaflet electronically, the majority prefer the patient information leaflet in paper form. Providing appropriate and useful eHealth services for patients to access the patient information leaflet electronically, along with education, could prepare patients for a transition to electronic patient information leaflet. © 2016, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved.

  • 210.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ohlson, Mats
    Med Prod Agcy, Uppsala.
    Hanson, Elizabeth
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Implementation of information systems at pharmacies – a case study from the re-regulated pharmacy market in Sweden2015In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 11, no 2, p. E85-E99Article in journal (Refereed)
    Abstract [en]

    Background

    When the Swedish pharmacy market was re-regulated in 2009, Sweden moved from one state-owned pharmacy chain to several private pharmacy companies, and four new dispensing systems emerged to replace the one system that had previously been used at all Swedish pharmacies for more than 20 years.

    Objectives

    The aim of this case study was to explore the implementation of the new information systems for dispensing at pharmacies.

    Methods

    The vendors of the four dispensing systems in Sweden were interviewed, and a questionnaire was sent to the managers of the pharmacy companies. In addition, a questionnaire was sent to 350 pharmacists who used the systems for dispensing prescriptions.

    Results

    The implementation of four new dispensing systems followed a strict time frame set by political decisions, involved actors completely new to the market, lacked clear regulation and standards for functionality and quality assurance, was complex and resulted in variations in quality. More than half of the pharmacists (58%) perceived their current dispensing system as supporting safe dispensing of medications, 26% were neutral and 15% did not perceive it to support a safe dispensing. Most pharmacists (80%) had experienced problems with their dispensing system during the previous month. The pharmacists experienced problems included reliability issues, usability issues, and missing functionality.

    Conclusion

    In this case study exploring the implementation of new information systems for dispensing prescriptions at pharmacies in Sweden, weaknesses related to reliability, functionality and usability were identified and could affect patient safety. The weaknesses of the systems seem to result from the limited time for the development and implementation, the lack of comprehensive and evidence-based requirements for dispensing systems, and the unclear distribution of quality assurance responsibilities among involved stakeholders.

  • 211.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Villius Zetterholm, My
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Patients’ views on information about medications: a pharmacy-based survey focusing on their information sources and experiences of pharmacists using a clinical decision support system2022In: Proceedings of the 18th International Symposium on Health Information Management Research (ISHIMR 2020): Kalmar, 17-18 September 2020 / [ed] Peter Bath, Päivi Jokela and Laura Sbaffi, Linnaeus University Press , 2022, Vol. 2020Conference paper (Refereed)
    Abstract [en]

    The aim of this study was to describe patients’ views on information regarding their medication with focus on their experiences with community pharmacists’ use of the clinical decision support system EES (electronic expert support system). This study was performed as a survey among patients who were collecting prescription medication at seven Swedish community pharmacies, with 281 respondents (response rate of 68%). Results show that patients receive information regarding their medication from many different sources, with differences related to age and gender. In general, most patients seemed satisfied with the information they had about their medicines, and with the information they got from pharmacists. The study also show that knowledge about how pharmacists work to improve medication safety and how they use EES is low. However, results indicate that many patients have high trust in pharmacists, expect them to check for potential drug related problems and are positive to pharmacists using EES more.

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  • 212.
    Hansson, Eric
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Olsson, Moa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Den mentala hälsan hos patienter som behandlas för våt AMD: En pilotstudie2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 213.
    Hansson, Petra
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Utvärdering av ögontorrhetsparametrar och synskärpa hos patienter som fått Visian ICL implanterat2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The Visian Implantable Collamer Lens (ICL) is a lens implanted into the posterior chamber as an intraocular lens. It is effective for moderate to high ametropia correction. The ICL increases contrast sensetivity and the method is reversible (Iagarashi et al., 2014).

    The aim of this study was to evaluate dry eye parameters and visual acuity in Visian ICL patiens and then compare with a previous study about LASIK to see which method that gave the least impact on the patients tear film, and to examine with which method patients experienced least dry eye problems.

    Method: A group of six patients who had ICL lenses implanted were examined on the day of the surgery and then about three weeks after surgery. The same examination was conducted before and after surgery, an OSDI questionnaire containing 12 questions about dry eye symptoms, lipid layer, NITBUT and tear meniscus were evaluated using a Tearscope, and visual acuity measured and compared with their preoperative fully corrected visual acuity.

    Results: 5 people felt that they had less dry eye symptoms postoperatively. 6 eyes showed a thinner lipid layer postoperatively, 2 eyes had a thicker lipid layer postoperatively and 4 eyes had an unchanged lipid layer. 5 eyes showed a thinner tear meniscus postoperatively, 2 eyes showed a thicker tear meniscus postoperatively and 5 eyes showed an unchanged result. The mean NITBUT significantly increased from 16.8±6,7 to 20.3±8,9 seconds postoperatively, an increase of 3.2 seconds. 2 eyes had a poorer visual acuity postoperatively, 4 eyes showed an improved visual acuity postoperative and 6 eyes shows an unchanged result.

    Conclusion: This study indicates that the Visian ICL is a good and safe method of vision correction and that the method provides fewer side effects regarding dry eye symptoms than LASIK.

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  • 214.
    Hattini, Ahmed
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    En litteraturstudie om de senaste behandlingsalternativen för keratoconus.2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att hitta de senaste behandlingsmodaliteterna som finns tillgängliga för behandling av keratoconus genom att genomföra en litteraturstudie.

    Metod: En enkel sökfråga för keratoconusbehandling gjordes i databasen av National Library of Medicine Website (pubmed.gov). Olika filter användes för att få resultat inom de senaste 5 åren. De var uppdelade enligt ämnet för varje artikel i tre kategorier: Icke-kirurgisk hantering, kirurgisk hantering och strategier för hantering och protokoll av keratoconus.

    Resultat: Totalt 459 artiklar erhölls. Av alla dessa valdes 18 ut för den nuvarande studie. Fyra artiklar var i den icke kirurgisk kategori, 12 artiklar i kirurgisk kategori, medan två var i kategorin om strategier för hantering och protokoll av keratoconus. Icke-kirurgiska modaliteter för behandling av mild till måttlig keratoconus har fortfarande stor inverkan, särskillt med tillkomsten av nya hybridlinser. Kirurgisk behandling av avancerade fall av keratoconus ger fortfarande bra resultat. Utvecklingen av hanteringsprotokollet och hanteringsstrategier har nått nya fronter baserade på de olika behandlingsalternativen som finns tillgänliga idag.

    Slutsats: En genomgripande förbättring kan ses vid behandling av keratoconus de senaste åren, tack vare nya tekniker och utveckling av gamla. Optiker tillsammans med ögonläkare har sin roll i att förbättra livskvaliteten hos keratoconus patienter.

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  • 215.
    Hector, Sven
    et al.
    Region Kronoberg, Sweden;Central Hospital Växjö, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Lund University, Sweden.
    Landin-Olsson, Mona
    Lund University, Sweden.
    Hillman, Magnus
    Lund University, Sweden.
    Melin, Eva Olga
    Lund University, Sweden.
    Soluble CD163 and glycated haemoglobin were independently associated with the progression of diabetic retinopathy in adult patients with type 1 diabetes2023In: BMJ Open Ophthalmology, E-ISSN 2397-3269, Vol. 8, no 1, article id e001314Article in journal (Refereed)
    Abstract [en]

    ObjectiveHigh vitreous levels of soluble (s)CD163 have been demonstrated in severe diabetic retinopathy (DR). The aim of this study was to explore the predictive values of plasma sCD163 and glycated haemoglobin (HbA1c) for DR progression in adults with type 1 diabetes. Methods and analysesThe study design was prospective. Fundus photography performed in 2009 and at follow-up (& LE;12 years later) were compared after being categorised according to the International Clinical Diabetic Retinopathy Disease Severity Scale. 'DR progression at least one level' was calculated. In 2009, data collection (sex, age, diabetes duration, metabolic variables, serum creatinine, macroalbuminuria and lifestyle factors) and biochemical analyses were performed. Plasma sCD163 and HbA1c were divided into quartiles. Logistic regression analyses were performed. ResultsThe prevalence of DR in 2009 versus at follow-up in 270 participants (57% male) were: no apparent 28% vs 18%; mild 20% vs 13%; moderate 24% vs 26%; severe 11% vs 13%; and proliferative DR 17% vs 30% (p<0.001). DR progression occurred in 101 (45%) patients. HbA1c & GE;54 mmol/mol (& GE;7.1%) (>1st quartile) (adjusted odds ratio (AOR) 3.8, p<0.001) and sCD163 & GE;343 ng/mL (>1st quartile) (AOR 2.6, p=0.004) were independently associated with DR progression. The associations with DR progression increased significantly from the first to the fourth quartile for HbA1c (AORs: 1; 2.5; 3.6; 7.4), but not for sCD163 (AORs: 1; 2.9; 2.4; 2.4). ConclusionPlasma sCD163 may constitute a valuable biomarker for DR progression in addition to and independent of the well-established biomarker HbA1c.

  • 216.
    Hedin, Pernilla
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Gholami, Reza
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Effekten av omega-3 på Dry Eye Disease: En litteraturstudie2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose. This literature study aimed to investigate whether oral omega-3 supplements affect dry eyes.

    Method. This literature review was based on five selected articles from the search engine Pubmed on 28 March. The keywords were "omega 3 supplement AND dry eye". There was inclusion criteria such as articles published between the years 2015 and 2022 and the articles needed to be Peer-reviewed randomized controlled trials. Articles in line with the purpose of this literature study were selected, and the outcome was four articles. The last article selected was one out of three included in the “suggestions for citation matching” by Pubmed, using the above-mentioned criteria.

    Results. Of the five articles, two articles could support a promoting effect of omega-3 on DED. One article showed a statistically significant positive impact on symptoms in OSDI scores in a subgroup with severe symptoms ≥ 52. In the two articles that could support a promoting effect of omega-3 on DED, a positive, statistically significant impact could be seen on OSDI scores, tear osmolarity, TBUT, and more. Two of the articles could not support a positive effect of omega-3 on DED. Even though there were positive effects on corneal staining, Schirmer´s test, conjunctival staining, and TBUT, they were not statistically significant compared with the placebo group. However, the number of participants varied between studies, which also varied for age, region, the composition of the fatty acids, and bioavailability of the supplement.Conclusion. The effect of omega-3 on DED varies between studies. The actual composition of the fatty acids seems to impact the result where increased bioavailability of omega-3, which is in re-esterified form, and krill oil that is in triglyceride form has a more significant effect than omega-3 in ethyl ester form. The addition of GLA to the omega-3 supplement also positively impacted symptoms in people with severe symptoms. More studies are needed to thoroughly understand the dose and form of omega-3, and severity of DED. But studies are also required to learn about individualized therapy, and if it can be applicable using omega-3 on DED.

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  • 217.
    Helgesson, Elin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Dunbrant, Carl
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Lönesituationen år 2021 i Sverige för nyutexaminerade optiker2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to present a picture of the salary situation and the factors that affect the salary of a newly graduated optician with contact lens qualification in the year 2021. Furthermore, the purpose of the study was to analyse the differences in salary from the perspective of geography and history.  This was done by using previous studies and collected statistics from Sweden and by new research about the subject by interviewing different stores around the country and through a survey sent out to optometry students in Sweden. The result of the survey showed that 94.6% of students had a job after graduation while only 5.4% answered that they did not have work as an optician after graduation. The highest salary was 37 000 SEK and the lowest was 28 000 SEK. The most common salary was 32 000 SEK which 12 perpictants have indicated as receiving. The mean salary was 31 497  SEK. 64.7% of the participants indicated that they felt satisfied with their starting salary, while 35.3% expressed their unhappiness with their starting salary. The most common wish for a starting salary was 32 000 SEK, closely followed by a wish for 30 000 SEK and the mean was at 32 635  SEK. The results from the interviews regarding the salaries was a mean at 31 750 SEK for the whole of Sweden. In the north of Sweden the mean was 33 083  SEK, in the south 31 042 SEK, in the east 31 500 SEK and last in the west the mean was 31 375 SEK. This was based on an interview with 40 different optometry stores, with 10 stores from each of the 4 cardinal directions.  What one can conclude is that there could be quite a difference in starting salary; the difference between the highest and lowest salary according to our survey was 9000 SEK. The most common salary was 32 000 SEK. The salary most graduates wanted was higher than what most of them got, and 35.3 % of them were unhappy with the salary they got. There was not a big difference between the salary in the different parts of Sweden, or any significant difference between big and small cities as a whole. Salaries in Kalmar were the lowest of all the places studied. If the participants were content or dissatisfied with their salary it was very individual and no clear connection between the satisfaction and salary could be found

  • 218.
    Helgesson, Sofie
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hur påverkar färgade kontaktlinser färgseendet?2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to examine how tinted contact lenses affect color vision and which wavelengths of the visible light that is transmitted through them.

     

    A total of 30 people in the range from 19 to 52 years were included in this study. They had refractive errors from about +5.00 D to -10.00 D and no cylinder power over

    -0.75 D. An eye exam was made and their current power was put in a trial frame, the eye that was not examined was occluded. A Farnsworth D-15 color arrangement test was made to examine color vision without tinted contact lenses and was then repeated with each of the three plano contact lenses in the colors Blue, Green and Sherry. A Spectrophotometer was used to measure the transmittance of visible light through the contact lenses.

     

    There was a significant difference with the Blue contact lens on the mean error score (p < 0.05) compared to without contact lens. With the contact lenses Green and Sherry was there no significant difference (p > 0.05 for both). The transmittance through the Blue contact lens had a minimum at 590 nm, Green at 600 nm and Red at both 510 nm and 540 nm. Both the Green and Red contact lenses the transmittance decreased considerably after 530 nm and 480 nm respectively.

     

    There was a significant difference in color vision with the Blue contact lens, but no difference with the Green and Red contact lenses. Tinted contact lenses have no direct effect on color vision when measuring with a Farnsworth D-15 color arrangement test. The transmittance decreased most at the complementary color of each contact lens, but with the Green and Red contact lenses the transmittance also decreased in the blue range of the visible wavelengths.

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  • 219.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kalmar County, Sweden.
    Eriksson, Tommy
    Malmö University, Sweden.
    Bondesson, Åsa
    Skåne County Council, Sweden.
    Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems2021In: European journal of hospital pharmacy. Science and practice, ISSN 2047-9956, E-ISSN 2047-9964, Vol. 28, no e1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from the medication reconciliation process. There is a need also to describe the medication review process.

    OBJECTIVE: To describe the frequency and types of drug-related problems (DRPs) identified during medication reviews and to evaluate the actions of the pharmacists and the physicians regarding the identified DRPs.

    METHOD: Structured medication reviews were conducted by a multi-professional team on top of standard care for 719 patients in two internal medicine wards in a Swedish University Hospital. The medication reviews were studied retrospectively to classify DRPs and actions taken.

    RESULTS: A total of 573 (80%) of patients had at least one actual DRP; an average of three DRPs per patient and in total 2164. Wrong drug and adverse drug reaction were the most common types of DRPs. The most frequent medication groups involved in DRPs were drugs for the cardiovascular system and the nervous system and the most frequent substances were warfarin, digoxin, furosemide and paracetamol. The 10 most common medications accounted for 27% of the actual DRPs. Of the identified DRPs, a total of 1740 (80%) were acted on. The three most common types of adjustments made were withdrawal of drug therapy, change of drug therapy and initiation of drug therapy. When the pharmacist suggested an adjustment, the physician implemented 88% (1037/1174) of the recommendations.

    CONCLUSION: DRPs are common among elderly patients who are admitted to hospital. Systematic identification of high-risk medications and common DRP types enables targeting of prioritised patients for medication reviews.

  • 220.
    Hellström, Lina
    et al.
    Kalmar County Council, Sweden.
    Johansson Östbring, Malin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Patients with coronary heart disease who have negative beliefs about their medicines report lower adherence2019In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 41, no 1, p. 343-343Article in journal (Other academic)
  • 221.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Council.
    Throfast, Victoria
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    General beliefs about medicines among independent elderly adults in Sweden: data from an RCT2017In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 39, no 1, p. 223-224, article id PH009Article in journal (Refereed)
  • 222.
    Henrysson, Ida
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus Univ, Dept Med & Optometry, Bergen, Norway..
    Theagarayan, Baskar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Binocular Vision, Reading Ability and Associated Symptoms in School Children2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7, p. 530-Article in journal (Other academic)
    Abstract [en]

    Purpose: The purpose of this study was to investigate relationship between binocular vision, reading ability and any associated symptoms in School Children.

    Methods: The study was conducted in a School in western Sweden. A sample of 54 Children aged between 10 and 12 years were invited to participate in this study. A consent form and a letter with information was sent to their parents. Children with at least 20/25 and N6 visual acuity and good Stereopsis were included. After receiving consent forms, 27 Children participated in all the measurements. Amplitude of accommodation was measured using push-up method both monocularly and binocularly. Accommodative facility was measured using ± 2.00 D flippers at 40 cm both monocularly and binocularly. Near point of convergence was measured using a Royal Air Force (RAF) ruler and both break and recovery points were documented. All the Children performed a group of reading ability tests to detect whether they have any reading difficulties. A questionnaire called "The College of Optometrists in Vision Development Quality of Life (COVD-QOL)" was filled by their parents together with their Children. A score of 20 or more is considered as symptomatic.

    Results: Mean amplitude of accommodation was OD 10.8 ± 4.0 D, OS 11.8 ± 4.1 D and OU 14.2 ± 3.7 D. Amplitude of accommodation was low in terms of Hofstetter's formula. Based on age, 59% of the Children were below expected value. The accommodative facility was lower than expected, with mean values of OD 5.5 ± 4.0 cpm, OS 5.5 ± 4.0 cpm and OU 5.0 ± 3.5 cpm. Mean near point of convergence was 6.0 ± 5.4 cm for break and 6.6 ± 5.9 cm for recovery. In the reading ability tests all the Children had normal values. Three Children received ≥ 20 points on the symptom questionnaire COVD-QOL, which is considered to be high. All of these three Children had values below normal limits for the amplitude of accommodation and/or the accommodative facility. Regression analysis showed no significant correlation between binocular vision tests, reading ability and symptom score (r < 0.6; p > 0.05).

    Conclusions: Amplitude of accommodation and accommodative facility was lower than expected values for their age. Near point of convergence values reached the expected normal level. There was no significant correlation between binocular vision tests, reading ability and associated symptoms in this sample of Swedish Children.

  • 223.
    Hernandez-Moreno, Laura
    et al.
    University of Minho Braga, Portugal.
    Moreno Perdomo, Natacha
    Hospital Santa Maria Maior E.P.E-Barcelos, Portugal.
    Aleman, Tomas S.
    University of Pennsylvania, USA.
    Baskaran, Karthikeyan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho Braga, Portugal.
    Absent Foveal Pit, Also Known as Fovea Plana, in a Child without Associated Ocular or Systemic Findings2018In: Case Reports in Ophthalmological Medicine, ISSN 2090-6722, E-ISSN 2090-6730, p. 1-5, article id 2146826Article in journal (Refereed)
    Abstract [en]

    The purpose of this report is to describe a case of bilateral foveal hypoplasia in the absence of other ophthalmological or systemic manifestations. We characterize the case of a 9-year-old Caucasian male who underwent full ophthalmologic examination, including functional measures of vision and structural measurements of the eye. Best corrected visual acuity was 0.50 logMAR in the right eye and 0.40 logMAR in the left eye. Ophthalmoscopy revealed a lack of foveal reflex that was further investigated. Optical coherence tomography (OCT) confirmed the absence of foveal depression (pit). OCT images demonstrated the abnormal structure of retina in a region in which we expected a fovea; these findings were decisive to determine the cause of reduced acuity in the child.

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  • 224.
    Hernández-Moreno, Laura
    et al.
    Univ Minho, Portugal.
    Senra, Hugo
    Univ Essex, UK;Univ Coimbra, Portugal.
    Lewis, Peter
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Moreno, Natacha
    Hosp Santa Maria Maior EPE, Portugal.
    Linhares, João
    Univ Minho, Portugal.
    Santana, Rui
    Univ NOVA, Portugal.
    Lima Ramos, Pedro
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portugal.
    Marques, Ana Patrícia
    Univ NOVA, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Univ Minho, Portugal.
    Cost‐effectiveness of basic vision rehabilitation (The basic VRS‐effect study): study protocol for a randomised controlled trial2020In: Ophthalmic & physiological optics, ISSN 0275-5408, E-ISSN 1475-1313, Vol. 40, no 3, p. 350-364Article in journal (Refereed)
    Abstract [en]

    Abstract Purpose To investigate the cost-effectiveness of a basic vision rehabilitation service (basic-VRS) in Portugal. We designed a parallel group, randomised controlled trial whose aim is to compare the effects and costs of ?usual low vision care? with a ?basic-VRS intervention? on self-reported visual ability and other psychosocial and health-related quality-of-life outcomes. Methods The trial will recruit participants that meet the following inclusion criteria: (1) visual acuity between 0.4?1.0 logMAR in the better-seeing eye, (2) cause of vision loss is diabetic retinopathy or age-related macular degeneration, (3) 18 years or older and iv) live in the community (not in nursing homes or other type of institution). Participants will be randomised to one of the study arms consisting of immediate intervention and delayed intervention. The delayed intervention group will receive ?usual care? or no intervention in the first 12 weeks. Visual acuity, contrast sensitivity and retinal structure will be assessed during the study. Results The primary outcome measure is visual ability, which will be evaluated with the Massof Activity Inventory, we expect that the intervention will raise the overall person measure or visual ability. Reading, health-related quality-of-life, anxiety and depression and social support will be also assessed. The analysis will be undertaken on an intention-to-treat basis. A cost-effectiveness analysis will be performed to provide information about the cost per unit of utility. To evaluate the cost-effectiveness of the intervention we will adopt the perspective of the healthcare system. Conclusion This study will provide additional evidence about the effects of basic-VRS on self-reported visual ability. Findings from this study should also contribute to better planning of low vision provision and, consequently, may contribute to reduce barriers to basic-VRS.

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  • 225.
    Hernández-Moreno, Laura
    et al.
    University of Minho, Portugal.
    Senra, Hugo
    University of Coimbra, Portugal;University of Essex, UK.
    Marques, Ana Patricia
    London School of Hygiene and Tropical Medicine, UK;University of Lisbon, Portugal.
    Perdomo, Natacha Moreno
    Hospital Santa Maria Maior E.P.E., Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. University of Minho, Portugal.
    The Basic VRS-Effect Study: Clinical Trial Outcomes and Cost-Effectiveness of Low Vision Rehabilitation in Portugal2023In: Ophthalmology and Therapy, ISSN 2193-8245, E-ISSN 2193-6528, Vol. 12, p. 307-323Article in journal (Refereed)
    Abstract [en]

    Introduction

    The aim of this study was twofold: (1) to investigate the clinical impact of vision rehabilitation in patients with vision impairment and (2) to investigate the cost-effectiveness of a basic vision rehabilitation service in Portugal.

    Methods

    The trial recruited patients diagnosed with age-related macular degeneration or diabetic retinopathy (DR) and visual acuity in the range 0.4–1.0logMAR in the better-seeing eye. Participants were randomised to one of the study arms consisting of immediate intervention and delayed intervention. The intervention included: new refractive correction, optical reading aids, in-office training and advice about modifications at home. Visual ability, health-related quality of life and costs were measured. Economic analysis was performed to evaluate whether the intervention was cost-effective. The trial compared the outcomes 12 weeks after the start in both arms.

    Results

    Of the 46 participants, 34 (74%) were diagnosed with DR, 25 (54%) were female, and mean age was 70.08 years (SD = 8.74). In the immediate intervention arm visual ability increased a mean of 0.523 logits (SE = 0.11) (p < 0.001). Changes in the delayed intervention arm were not statistically significant (p = 0.95). Acuity in the better-seeing eye, near acuity and critical print size also improved during the study. The mean cost of the intervention was €118.79 (SD = 24.37). The incremental cost-effectiveness ratio using the EQ-5D-5L was 30,421€/QALY and 1186€/QALY when using near acuity.

    Conclusion

    The current study gives evidence of positive clinical impact of a basic vision rehabilitation intervention and shows that a basic vision rehabilitation service is cost-effective. These findings are important to clinical and rehabilitation practices and for planning vision rehabilitation services.

    Trial Registration

    Retrospectively registered, 21/01/2019. ISRCTN10894889, https://www.isrctn.com/ISRCTN10894889

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  • 226.
    Hernández-Moreno, Laura
    et al.
    University of Minho, Portugal.
    Senra, Hugo
    University of Coimbra, Portugal;University of Essex, UK.
    Moreno, Natacha
    Hospital Santa Maria Maior E.P.E, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. University of Minho, Portugal.
    Is perceived social support more important than visual acuity for clinical depression and anxiety in patients with age-related macular degeneration and diabetic retinopathy?: Är uppfattat socialt stöd viktigare än synskärpa för klinisk depression och ångest hos patienter med åldersrelaterad makulär degeneration och diabetesretinopati?2021In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 35, no 9, p. 1341-1347Article in journal (Refereed)
    Abstract [en]

    Objective:To investigate whether visual acuity has the same importance as a factor of depression and anxiety comparing with other psychological variables, particularly perceived social support, in patients diagnosed with age-related eye diseases, with and without low vision.

    Design:Observational cross-sectional study.Setting:Patients attending outpatient appointments at the department of ophthalmology of a general hospital in Portugal.

    Subjects:Patients with age-related macular degeneration and patients with diabetic retinopathy attending routine hospital appointments were recruited for this study.

    Measures:Anxiety and depression were measured using the hospital anxiety and depression scale and perceived social support using the multidimensional scale of perceived social support. Visual acuity was measured with ETDRS charts.Results:Of the 71 patients, 53 (75%) were diagnosed with diabetic retinopathy, 37 (52%) were female and age (mean±SD) was 69±12 years. Acuity in the better seeing eye was 0.41±?0.33logMAR. The mean anxiety score was 4.38±3.82 and depression 4.41±3.39. Clinically significant levels of anxiety were found in 21% (n=15) of the participants and depression in 18%(n=13). The total social support score was 5.29±0.61. Significant multivariate regression models were found for anxiety (R2=0.21, P=0.016) and for depression (R2=0.32, P<0.0001). Social support was independently associated with levels of anxiety and with levels of depression. Gender was independently associated with levels of anxiety.

    Conclusion:This study suggests that patients? perceived social support might be more important than visual acuity as a factor of clinical depression and anxiety in a sample of age-related eye disease patients.

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  • 227.
    Hjalmarsson, Kim
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Larsdotter, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Correlation of time spent outdoors with refractive error and axial length in Swedish schoolchildren2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: The purpose of this study was to objectively measure time spent outdoors in natural light and correlate it with refractive error, axial length in Swedish schoolchildren. 

    Method: A total of 24 participants aged between 10 -18 were given an accelerometer to be worn on their wrist. The participants wore the accelerometer for a median of 5 days (range: 2 to 8 days). A cutoff of 1000 lux was used to define the time spent outdoors. The time spent outdoors was collected and correlated with the participant’s spherical equivalent refraction and axial length. Information obtained through a questionnaire was used to compare objective measurement with subjective self-reported measure. 

    Results: A non-statistically significant relationship was found between outdoor time, spherical equivalent refraction (Spearman rho = 0.16, p = 0.45) and axial length (Spearman rho = -0.28, p = 0.18). A relationship that was statistically significant could be found between outdoor time and age (Spearman rho = -0.50, p = <0.05), as well as between objectively measured outdoor time and subjectively reported outdoor time with Wilcoxon signed rank test with z = -3.0 p <0.01 

    Conclusion: Even though this study did not find any statistically significant correlation, there was a general trend that children with negative refraction and longer axial length tend spend less time outdoors. Moreover, children tend to overestimate self-reported time spent outdoors compared to the actual measurements. 

  • 228.
    Hofflander, Malin
    et al.
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Nilsson, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Grundbok i e-hälsa2020 (ed. 1)Book (Other academic)
    Abstract [sv]

    Grundbok i eHälsa ger en inblick i områden som studenter inom hälso- och sjukvård behöver för att möta digitaliseringen. Genom att tillämpa en tvärvetenskaplig strategi för att beskriva digitaliseringen inom hälso- och sjukvården synliggörs komplexiteten i olika situationer när eHälsolösningar introduceras och implementeras.

    Boken har tre delar. Den första, individperspektivet, fokuserar på etiska aspekter, evidens och patientsäkerhet, liksom vikten av att arbeta personcentrerat när individens vardag digitaliseras. Den andra, organisationsperspektivet, handlar om ledning och styrning. Den tar upp förändringskunskap, förändringsledning och hur införandeprocesser bör bedrivas för att bli framgångsrika. Den sista delen, samhällsperspektivet, behandlar ansvar, nytta och ekonomi på olika nivåer när verksamheter inom hälso- och sjukvården digitaliseras. Varje del tar avstamp i en exempelberättelse och avslutas med frågor för egna funderingar och samtal.

  • 229.
    Hoffman, Robert D.
    et al.
    Tel Aviv Univ, Israel.
    Thielmann, Anika
    Univ Duisburg Essen, Germany.
    Buczkowski, Krzysztof
    Nicolaus Copernicus Univ, Poland.
    Edirne, Tamer
    Univ Pamukkale, Turkey.
    Hoffmann, Kathryn
    Med Univ Vienna, Austria.
    Koskela, Tuomas
    Tampere Univ, Finland.
    Lingner, Heidrun
    Hannover Med Sch, Germany.
    Mevsim, Vildan
    Dokuz Eylul Univ, Turkey.
    Tekiner, Selda
    Ankara Univ, Turkey.
    Zielinski, Andrzej
    Region Blekinge, Sweden.
    Hoffman Cicurel, Naomi
    Sheba Acad Med Ctr Hosp, Israel.
    Petrazzuoli, Ferdinando
    Italian Soc Gen Practitioners, Italy;Lund University, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Lund University, Sweden.
    Gerasimovska Kitanovska, Biljana
    Univ St Cyril & Methodius, North Macedonia.
    Weltermann, Birgitta
    University of Bonn, Germany.
    Gender differences in self-care for common colds by primary care patients: a European multicenter survey on the prevalence and patterns of practices (the COCO study)2021In: Journal of Gender Studies, ISSN 0958-9236, E-ISSN 1465-3869, Vol. 30, no 7, p. 756-771Article in journal (Refereed)
    Abstract [en]

    Although generally harmless, the common cold disturbs the lives of billions yearly. It is frequently treated by self-care, yet little is known about the effect gender may have on self-care. Our study set out to discover whether self-care for common colds differs by gender. We also wanted to test the 'Man cold' belief: that men 'break down' when they have a cold and suffer more than women when they are sick. We distributed questionnaires asking for a selection of self-care practices in eight categories to 3,240 consecutive patients in 14 Eurasian countries at 27 primary care sites. Of 2,654 patients included, 99% reported engaging in self-care for common colds. Discomfort was reported more frequently by women (74.7% vs. 66.5%, p < 0.001). There were gender differences in several self-care categories. The mean use of self-care items was higher in women than in men (12.0 vs. 10.3, p < 0.001). Women reported a greater variety of self-care items than men. However, more men reported using alcohol (17.8% vs. 8.4%, p < 0.001). This cross-national study documented gender differences in self-care for common colds.

  • 230.
    Hoffmann, Mikael
    et al.
    Linköping University, Sweden.
    Vander Stichele, Robert
    Univ Ghent, Belgium.
    Bates, David W.
    Brigham & Womens Hosp, USA;Harvard Med Sch, USA.
    Björklund, Johanna
    Umeå University, Sweden.
    Alexander, Steve
    Univ Nottingham, UK.
    Andersson, Marine L.
    Karolinska Institutet, Sweden.
    Auraaen, Ane
    Org Econ Cooperat & Dev OECD, France.
    Bennie, Marion
    Univ Strathclyde, UK.
    Dahl, Marja-Liisa
    Karolinska Institutet, Sweden.
    Eiermann, Birgit
    Karolinska Institutet, Sweden.
    Hackl, Werner
    UMIT Private Univ Hlth Sci Med Informat & Technol, Austria.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Hjemdahl, Paul
    Karolinska Institutet, Sweden.
    Koch, Sabine
    Karolinska Institutet, Sweden.
    Kunnamo, Ilkka
    Finnish Med Soc Duodecim, Finland.
    Le Louet, Herve
    Council Int Org Med Sci CIOMS, Switzerland.
    Panagiotis, Papapetrou
    Stockholm University, Sweden.
    Raego, Lembit
    Council Int Org Med Sci CIOMS, Switzerland.
    Spedding, Michael
    Int Union Basic & Clin Pharmacol IUPHAR, France.
    Seidling, Hanna M.
    Heidelberg Univ, Germany.
    Demner-Fushman, Dina
    NIH, USA.
    Gustafsson, Lars L.
    Karolinska Institutet, Sweden;Swedish Institute for Drug Informatics (SIDI), Sweden.
    Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems: report by an international expert workshop at Karolinska Institutet2020In: Expert Review of Clinical Pharmacology, ISSN 1751-2433, E-ISSN 1751-2441, Vol. 13, no 9, p. 925-934Article in journal (Refereed)
    Abstract [en]

    Introduction Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap. Areas covered The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed. Expert opinion Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preferences. This field can progress by the establishment of an international policy group for developing a best practice guideline on the development, maintenance, governance, evaluation principles and financing of open-source knowledge bases and handling of real-world data.

  • 231.
    Holmgren, C.
    et al.
    County Hospital Ryhov, Sweden;University of Gothenburg, Sweden;Sahlgrenska University Hospital, Sweden.
    Abdon, N. J.
    Hudiksvall Hospital, Sweden.
    Bergfeldt, L.
    University of Gothenburg, Sweden;Sahlgrenska University Hospital, Sweden.
    Edvardsson, N.
    Sahlgrenska University Hospital, Sweden.
    Herlitz, J.
    University of Borås, Sweden.
    Karlsson, T.
    University of Gothenburg, Sweden.
    Nystrom, B.
    University of Gothenburg, Sweden;Sahlgrenska University Hospital, Sweden.
    Åstrand, Bengt
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Out-of-hospital cardiac arrest: Causes according to autopsy and electrocardiography - Analysis of 781 patients with neither hospital care nor prescribed medication during the preceding two years2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 150, no May, p. 65-71Article in journal (Refereed)
    Abstract [en]

    Background: There is a knowledge gap regarding aetiology of and potential for predicting out-of-hospital cardiac arrest (OHCA) among individuals whoare healthy before the event.Aim: To describe causes of OHCA and the potential for predicting OHCA in apparently healthy patients.Methods: Patients were recruited from the Swedish Register of Cardiopulmonary Resuscitation from November 2007 to January 2011. Inclusioncriteria were: OHCA with attempted CPR but neither dispensed prescription medication nor hospital care two years before the event The registerincludes the majority of patients suffering OHCA in Sweden where cardiopulmonary resuscitation (CPR) was attempted. Medication status was definedby linkage to the Swedish Prescribed Drug Register. Cause of death was assessed based on autopsy and the Swedish Cause of Death Register.Prediction of OHCA was attempted based on available electrocardiograms (ECG) before the OHCA event.Results: Altogether 781 individuals (16% women) fulfilled the inclusion criteria. Survival to 30 days was 16%. Autopsy rate was 72%. Based on autopsy,70% had a cardiovascular aetiology and 59% a cardiac aetiology. An ECG recording before the event was found in 23% of cases. The ECG wasabnormal in 22% of them.Conclusion: Among OHCA victims who appeared to be healthy prior to the event, the cause was cardiovascular in the great majority according toautopsy findings. A minority had a preceding abnormal ECG that could have been helpful in avoiding the event.

  • 232.
    Holmgren, Christina M.
    et al.
    University of Gothenburg, Sweden;County Hospital Ryhov, Sweden.
    Abdon, Nils J.
    Hudiksvall Hospital, Sweden.
    Bergfeldt, Lennart B.
    University of Gothenburg, Sweden.
    Edvardsson, Nils G.
    University of Gothenburg, Sweden.
    Herlitz, Johan D.
    University of Borås, Sweden;Sahlgrenska University Hospital, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Svensson, Leif G.
    Karolinska Institutet, Sweden.
    Åstrand, Bengt
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Changes in Medication Preceding Out-of-hospital Cardiac Arrest Where Resuscitation Was Attempted2014In: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 63, no 6, p. 497-503Article in journal (Refereed)
    Abstract [en]

    Objective: To describe recent changes in medication preceding out-of-hospital cardiac arrest (OHCA) where resuscitation was attempted. Methods: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a 6-month period before the OHCA compared with those claimed in the period 12 to 18 months before. The 7-digit Anatomical Therapeutical Chemical codes of individual drugs were used. The study period was November 2007-January 2011. Results: OHCA victims with drugs were (1) older than those who did not claim any drugs in any period (70 +/- 16 years vs. 54 +/- 22 years, P < 0.001), (2) more often women (34% vs. 20%, P < 0.001), and (3) had more often a presumed cardiac etiology (67% vs. 54%, P < 0.001). The OHCA victims were less likely to have ventricular tachycardia/ventricular fibrillation as the first recorded ;rhythm (26% vs. 33%, P < 0.001) or to survive 1 month (9% vs. 17%, P < 0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8%, and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the "qtdrugs.org" lists. Conclusions: Most OHCA victims had new drugs prescribed within 6 months before the event but most often intended for diseases other than cardiac. No claims can be made as to the causality.

  • 233.
    Holmén, Joacim
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Do I want an app for that?: Patients’ experiences of using a smartphone app for distance monitoring of depression2023Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Background: Non-adherence to pharmaceutical antidepressant treatment is common among patients suffering from depression. This can lead to a deterioration of depressive symptoms with a potential need for hospitalization and increased healthcare costs as an effect. Previous studies have shown that automatic self-monitoring systems through digital applications can be effective in increasing adherence to treatment. 

    Aim: Explore patients’ experiences of using a smartphone app on a daily basis for the first four weeks after being prescribed an antidepressant.

    Method: A qualitative descriptive study. Ten patients were recruited from an outpatient psychiatric clinic in Sweden. In connection to inclusion a nurse assisted with the installation of a digital application called Seno. Nine patients, seven females and two men ranging between 18–40 years, completed the study. Individual semi-structured interviews were conducted after using the app for four to six weeks. Recorded data was transcribed and analysed using qualitative content analysis.

    Results: The participants experienced that a digital application could be valuable as an augmentation to antidepressant treatment, but with room for improvement. Adherence was positively affected by a daily reminder and the application’s ease-of-use, but was negatively affected by technical issues, cognitive impairments and a lack of flexibility to tailor the content according to individual needs. The positive experience of visually presented data in graphs was a key finding and was found beneficial for self-awareness as well as for the patient-physician relationship, and engagement to continue using the application. Participants expressed no concerns regarding the safety of their health data when using the application.

    Conclusion: A digital solution for self-monitoring of depressive symptoms and adherence to medication can be found useful and is tolerated by patients when being prescribed, or making a change, in pharmaceutical antidepressant treatment. Several factors can impact the usability of, and engagement in, the digital application and need to be considered when designing this kind of solution. This indicates that there is a need for user involvement early on in the design process.

  • 234.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Swedish Family Care Competence Centre (NKA).
    Barn som anhöriga: ekonomisk studie av samhällets långsiktiga kostnader2015Report (Other academic)
    Abstract [sv]

    Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medför direkta och indirekta kostnader för samhället på kort och lång sikt. Denna hälsoekonomiska studie är en beräkning av samhällets årliga kostnad för den andel av befolkningen som vuxit upp som barn som anhörig till förälder med psykisk sjukdom eller missbruk av alkohol eller narkotika.

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  • 235.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    The impact of increasing polypharmacy on prescribed drug expenditure: A register-based study in Sweden 2005-2009.2013In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 109, no 2, p. 166-174Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To analyse the impact of the observed increase in the prevalence in polypharmacy on the development of prescribed drug expenditure (PDE) in a national population during five years.

    METHODS:

    A register-based study of all prescribed drugs and PDE for the entire Swedish population during a 3-month period in 2005 and 2009, respectively. The prevalence of "polypharmacy" and "excessive polypharmacy" was defined as the proportion of patients receiving five or more (PD≥5) and ten or more (PD≥10) prescribed drugs during a 3-month period, respectively.

    RESULTS:

    Between 2005 and 2009, the prevalence of polypharmacy increased by 8.3% (from 11.1% to 12.0%), and the prevalence of excessive polypharmacy by 9.9% (from 2.4% to 2.6%). Total PDE increased by 4.8% in real prices. For the group of patients with polypharmacy and excessive polypharmacy, PDE increased by 6.2%, and 7.3%, respectively. A simulation, in which the increase in polypharmacy was neutralised, resulted in no increase in total PDE.

    CONCLUSIONS:

    The increase in the prevalence of polypharmacy has a substantial impact on the increase in PDE and can explain the entire increase in PDE in Sweden during 2005 to 2009. For clinicians and healthcare stakeholders, it is important to monitor and guidance the further development in multiple medication therapy, so that the cost associated with increasing polypharmacy will not exceed its benefits.

  • 236.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Trends in Inappropriate Drug Therapy Prescription in the Elderly in Sweden from 2006 to 2013: Assessment Using National Indicators2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 5, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document "Indicators of appropriate drug therapy in the elderly" as a guideline for improving prescribing for the elderly. Objective The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment. Methods Individual-based data on dispensed prescription drugs for the entire Swedish population aged >= 65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored. Results For the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65-74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged >= 75 years), all indicators except excessive polypharmacy showed improvement. Conclusion According to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.

  • 237.
    Håkansson, Filip
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Johansson, Oskar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Samband mellan ögonbesvär och synavstånd till smartphone: En studie av universitetsstudenter på Linnéuniversitet i Kalmar2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att undersöka om ett kortare synavstånd till smartphone resulterar i mer ögonrelaterade symtom.

    Metod: Deltagarna var slumpmässigt tillfrågade mellan åldrarna 19 och 37 år. Deltagarna (n=63) fick svara på symtomenkäten Convergence insufficience symptom survey (CISS) gällande närseende och läsning. Under tiden mättes synavståndet mellan deltagarnas ögon och smartphone. Symtomenkäten var webbaserad och deltagarna svarade med sin smartphone. Höjden på versalen [H] mättes och tillsammans med synavståndet räknades synvinkeln ut.

    Resultat: 76% av deltagarna var kvinnor, 22% var män och 2% saknade könstillhörighet. Deltagarnas medelålder var 24 år. Studien indikerade inte på ett statistiskt signifikant samband (r=0,219, p=0,102) mellan CISS-poäng och synavstånd till smartphone. Däremot indikerades en svag korrelation mellan de två variablerna. Resultatet visade även att endast 2 deltagare i studien hade en mindre synvinkel än 16 bågminuter.

    Slutsats: Denna studie fann inget statistiskt signifikant samband mellan synavstånd till smartphone och astenopiska besvär. Däremot påvisar studien en svag korrelation mellan synavstånd till smartphone och astenopiska besvär.

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  • 238.
    Högberg, Cecilia
    et al.
    Umeå University, Sweden.
    Cronberg, Olof
    Lund University, Sweden;Region Kronoberg, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Lund University, Sweden;Region Kronoberg, Sweden.
    Lilja, Mikael
    Umeå University, Sweden.
    Jansson, Stefan
    Örebro University, Sweden;Uppsala University, Sweden.
    Gunnarsson, Ulf
    Umeå University, Sweden.
    Use of faecal immunochemical tests common in patients with suspected colorectal cancer but unrelated to travel distance to secondary care: a population-based study from Swedish primary care2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 4, p. 459-465Article in journal (Refereed)
    Abstract [en]

    Background Evidence is increasing for the use of faecal immunochemical tests (FITs) for occult blood as diagnostic tools when colorectal cancer can be suspected. FITs have been used for this purpose in Swedish primary care since around 2005 despite absence of supporting guidelines. To our knowledge, the extent of this use has not been studied. Objective To investigate the use of FITs as diagnostic tools, and if the use was related to patient age, sex and travel time from primary care to diagnostic facilities in secondary care. Design Population-based retrospective study using data from electronic health records. Setting and subjects Patients >= 18 years that provided FITs in primary care in five Swedish health care regions during 2015. Driving times from their primary care centres to secondary care were calculated. Main outcome measures The proportion of patients that provided FITs was calculated for each region, different age intervals and grouped driving times. Results 18,913 patients provided FITs. The proportion of listed patients in the five regions that provided FITs increased with age: 0.86-1.2% for ages <65 years, 3.6-4.1% for ages 65-79 years and 3.8-6.1% for ages >= 80 years. Differences between the regions were small. There was no overall correlation between the proportion of patients that provided FITs and driving time to secondary care. Conclusion FITs were used extensively in Swedish primary care with a higher use in older age groups. There was no tendency towards a higher use of FITs at primary care centres with longer driving times to secondary care.

  • 239.
    Högberg, Cecilia
    et al.
    Umeå University, Sweden.
    Gunnarsson, Ulf
    Umeå University, Sweden.
    Cronberg, Olof
    Lund University, Sweden;Region Kronoberg, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Lund University, Sweden;Region Kronoberg, Sweden.
    Lilja, Mikael
    Umeå University, Sweden.
    Jansson, Stefan
    Örebro University, Sweden.
    Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study2020In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 35, p. 2035-2040Article in journal (Refereed)
    Abstract [en]

    Background Rectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC. Methods Results of all FITs requested in primary care for symptomatic patients in the orebro region during 2015 were retrieved. Data on each patient's history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden. Results A total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1-13.4) and negative predictive value 99.7% (95% CI 99.2-100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6-10.9) and 100% (95% CI 99.6-100). Conclusion The diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.

  • 240.
    Högberg, Cecilia
    et al.
    Östersund Hospital, Sweden.
    Gunnarsson, Ulf
    Umeå University, Sweden.
    Jansson, Stefan
    Örebro University, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Lund university, Sweden.
    Cronberg, Olof
    Lund university, Sweden.
    Lilja, Mikael
    Umeå University, Sweden.
    Diagnosing colorectal cancer in primary care: cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts2020In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 70, no 701, p. E843-E851Article in journal (Refereed)
    Abstract [en]

    Background Colorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC. Aim To evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, atone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC. Design and setting A population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions. Method Patients aged >= 18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated. Results In total, 15 789 patients provided FITs (four different brands); of these patients, 304 were later diagnosed with CRC. Haemoglobin levels were available for 13 863 patients, and platelet counts for 10 973 patients. Calculated for the different FIT brands only, the sensitivities for CRC were 81.6%-100%; specificities 65.7%-79.5%: positive predictive values 4.7%-8.1%; and negative predictive values 99.5%-100%. Calculated for the finding of either a positive FIT or anaemia, the sensitivities increased to 88.9-100%. Adding thrombocytosis did not further increase the diagnostic performance. Conclusion Qualitative FITs requested in primary care seem to be useful as rule in tests for referral when CRC is suspected. A negative FIT and no anaemia indicate a low risk of CRC.

  • 241.
    Högstedt, Erika
    et al.
    Municipal Norrköping, Sweden;Linköping University, Sweden.
    Igelström, Kajsa
    Linköping University, Sweden.
    Korhonen, Laura
    Linköping University, Sweden.
    Käcker, Pia
    Linköping University, Sweden.
    Marteinsdottir, Ina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Björk, Mathilda
    Linköping University, Sweden.
    'It's like it is designed to keep me stressed' - Working sustainably with ADHD or autism2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 8, p. 1280-1291Article in journal (Refereed)
    Abstract [en]

    Background Adults with attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) face multiple challenges in obtaining and maintaining employment. Aims To identify and describe how adults with ADHD or ASD experienced their ability to work and what factors affected their ability to find a sustainable work situation over time. Methods Individual in-depth interviews were performed with 20 purposively sampled participants with ADHD/ASD. Data were analysed inductively using reflexive thematic analysis. Results Three themes were identified, describing (1) one's own cognitive abilities and challenges, (2) enablement by flexibility and acceptance in the work environment, and (3) accumulated stress that makes the work situation unsustainable over time. Conclusions Over time, a lack of continuity and predictability of support measures caused great stress and exhaustion, with severe consequences for working life and in life in general. Adaptations needed to be individually tailored and include nonoccupational factors. Significance The study shows that adults with ADHD/ASD need long-term interventions that flexibly adapt to individual needs, as they vary over time. The findings suggest that occupational therapists and other health care providers, employers, employment services and other involved agencies should pay a greater deal of attention to stability and predictability over time.

  • 242.
    Idh, Jonna
    et al.
    Linköping University.
    Andersson, Blanka
    Linköping University.
    Lerm, Maria
    Linköping University ; Karolinska Institutet.
    Raffetseder, Johanna
    Linköping University.
    Eklund, Daniel
    Linköping University.
    Woksepp, Hanna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Hospital.
    Werngren, Jim
    Public Health Agency Sweden.
    Mansjo, Mikael
    Public Health Agency Sweden.
    Sundqvist, Tommy
    Linköping University.
    Stendahl, Olle
    Linköping University.
    Schön, Thomas
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linköping University ; Kalmar County Hospital.
    Reduced susceptibility of clinical strains of Mycobacterium tuberculosis to reactive nitrogen species promotes survival in activated macrophages2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 7, article id e0181221Article in journal (Refereed)
    Abstract [en]

    Background Drugs such as isoniazid (INH) and pretomanid (PRT), used against Mycobacterium tuberculosis are active partly through generation of reactive nitrogen species (RNS). The aim of this study was to explore variability in intracellular susceptibility to nitric oxide (NO) in clinical strains of M. tuberculosis. Method Luciferase-expressing clinical M. tuberculosis strains with or without INH resistance were exposed to RNS donors (DETA/NO and SIN-1) in broth cultures and bacterial survival was analysed by luminometry. NO-dependent intracellular killing in a selection of strains was assessed in interferon gamma/lipopolysaccharide-activated murine macrophages using the NO inhibitor L-NMMA. Results When M. tuberculosis H37Rv was compared to six clinical isolates and CDC1551, three isolates with inhA mediated INH resistance showed significantly reduced NO-susceptibility in broth culture. All strains showed a variable but dose-dependent susceptibility to RNS donors. Two clinical isolates with increased susceptibility to NO exposure in broth compared to H37Rv were significantly inhibited by activated macrophages whereas there was no effect on growth inhibition when activated macrophages were infected by clinical strains with higher survival to NO exposure in broth. Furthermore, the most NO-tolerant clinical isolate showed increased resistance to PRT both in broth culture and the macrophage model compared to H37Rv in the absence of mutational resistance in genes associated to reduced susceptibility against PRT or NO. Conclusion In a limited number of clinical M. tuberculosis isolates we found a significant difference in susceptibility to NO between clinical isolates, both in broth cultures and in macrophages. Our results indicate that mycobacterial susceptibility to cellular host defence mechanisms such as NO need to be taken into consideration when designing new therapeutic strategies.

  • 243.
    Ingling, Allen W
    et al.
    Aeon Imaging, USA.
    Muller, Matthew S
    Aeon Imaging, USA.
    Green, Jason J
    Indiana Univ, USA.
    Gast, Thomas
    Aeon Imaging, USA ; Indiana Univ, USA.
    Haggerty, Bryan
    Indiana Univ, USA.
    Baskaran, Karthikeyan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Indiana Univ, USA.
    Clendenon, Jeffrey
    Aeon Imaging, USA.
    Stanfield, Kenneth A
    Aeon Imaging, USA.
    Elsner, Ann E
    Aeon Imaging, USA ; Indiana Univ, USA.
    Fixation stability readily obtained from confocal color fundus imaging2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7, p. 515-515Article in journal (Refereed)
    Abstract [en]

    PurposeStabile fixation underpins most visual tasks such as reading, and is important for accurate assessment of visual function and treatment. Retinal imaging instruments average images over time to improve the signal to noise ratio, discarding useful eye movement data. We determined whether the frame-to-frame motion of the retina during non-mydriatic color fundus imaging could provide fixation stability measures, e.g. Bivariate Contour Ellipse Area (BCEA). MethodsNon-mydriatic color fundus images were acquired using the Digital Light Ophthalmoscope (DLO). Twenty subjects with varied fundus pigmentation were tested without mydriasis. The DLO uses a digital light projector with LED light sources to provide the illumination for both confocal imaging and fixation stimuli. The DLO projects a series of lines across the fundus that is synchronized to the 2D CMOS sensor, providing high contrast confocal imaging. Monochromatic 40 deg images were acquired with alternating red and green LED illumination at 14.3 Hz and overlayed to present a pseudo-color image to the operator in real time. To reduce pupil constriction and patient discomfort, the green LED was long-pass filtered with a 570 nm filter. A 1.5mm entrance pupil and time-averaged power of &lt;30 uW were used. Images were aligned automatically with custom software (MATLAB) using cross-correlation and 2D translation. A canvas of twice the image size was used to allow image alignment despite moderate eye movements. Blinks and large saccades were discarded and BCEA was computed. ResultsThe image alignment algorithm successfully aligned nearly all the frames, rejecting 3.7%, and allowing fixation stability to be computed from color fundus image data. The BCEA for 1 standard deviation was 2.97 log minarc2 for all subjects and both the red and yellow-orange illumination. There was no difference between the BCEA for red or yellow-orange illumination (t = .86). ConclusionsThe color DLO records sufficiently high quality images to reliably calculate measures of fixation stability. Despite recruiting an especially challenging population that included dark fundi, small pupils, high refractive errors, and media issues, we achieved success in all subjects tested to date.

  • 244.
    Iqbal, Sarfraz
    et al.
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Jokela, Päivi
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Nilsson, Anna-Lena
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Sustainable Healthcare Systems: A holistic perspective on the use and impact of medication management robots in home healthcare2021In: Scandinavian Journal of Information Systems, ISSN 0905-0167, E-ISSN 1901-0990, Vol. 33, no 2, p. 181-214, article id 6Article in journal (Refereed)
    Abstract [en]

    This study focuses on medication management robotic system (MMR) in home health care, which is part of a complex medication management system that in addition to patients, their families, care personnel, municipal health and social care managers, and technology also includes prescribers and dispensing pharmacies. Successful medication management requires communication, coordination and effective information sharing among the network actors and across different settings. Information ecology perspective is used to describe and understand the whole system, the network of people, technology, and information systems, as well as the impact of MMR system on patients and caregivers’ relationships, roles, and responsibilities. This qualitative case study aimed to explore the impact of implementation and deployment of MMR system, as part of a pilot project in municipal eldercare in the south of Sweden. This research work elucidates the holistic perspective of medication management system for home care services, and highlights the processes and situational complexities, as well as the role of the personnel and key stakeholders involved in these processes. This research work is in line with UN’s sustainable development goals to develop a reliable, sustainable and resilient regional infrastructure, to support human well-being, with a focus on affordable and equitable access for all.

  • 245.
    Ismaiel, Baste
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Zetterström, Elin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Effekten av forityp vid Gradient AK/A mätning med plusglas och minusglas, samt kopplingen till CISS poäng2024Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: För att ta fram en gradient AK/A-kvot med Von Graefe-metoden använder sig optikern oftast av minusglas vid exo-deviation och plusglas vid eso-deviation. Det finns däremot källor som motsätter sig detta och anser att minusglas bör användas på samtliga patienter eftersom ackommodationen stimuleras av glaset under mätningen och ger ett mer pålitligt resultat. 

    Syfte: Syftet med denna studie var att undersöka betydelsen av att använda -1,00D glas vid exo-deviationer och +1,00D glas vid eso-deviationer vid utförandet av gradient AK/A, med avsikten att reda ut ifall det finns en funktionell grund för detta val. Dessutom, hur den resulterande Gradient AK/A-kvoten relaterar till respons AK/A-kvot och korrelerar med CISS-poängen.

    Metod: Deltagarna (n=41) var slumpmässigt tillfrågade mellan åldrarna 20 och 31. Inklusionskriterierna var personer mellan 18 och 35. Undersökningen började med en refraktion för att säkerställa att mätningarna utfördes på aktuell korrektion. Sedan utfördes fyra mätningar med Von Graefe, tre på nära och en på längre avstånd. De mätningar som gjordes på nära håll var en dissocierad forimätning, en mätning av gradient AK/A med -1,00D i add och en med +1,00D i add. Ordningen av de fyra fori mätningarna randomiserades för varje patient. Efter fori-mätningarna utfördes två mätningar med öppet fält refraktor för att ta reda på om personerna hade en ackommodativ lead eller en ackommodativ lag och även hur stor denna var. Deltagarna fick slutligen svara på en CISS-enkät. Resultaten från mätningarna och enkäten lades därefter in i JASP för att statistiskt undersökas. 

    Resultat: Utförda tester visade att det inte fanns någon signifikant skillnad mellan valet av lins baserat på foristatus. Det finns dock en signifikant skillnad beroende på användningen av plus- eller minus-glas under testet. Det sågs ingen korrelation mellan AK/A-kvot och CISS-poäng. Det fanns inte heller någon korrelation mellan gradient AK/A-kvot och respons AK/A-kvot.

    Slutsats: Användningen av +1,00D eller -1,00D vid utförandet av gradient AK/A-kvot ger olika resultat, oberoende av vilken deviation patienten har.

  • 246.
    Jannesson, Marina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Påverkas det intraokulära trycket i ögat vid dynamisk träning?2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 247.
    Jarlvi, Lovisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Eriksson, Linda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hur exsudativ nAMD påverkar synrelaterad livskvalitet: En kvantitativ enkätstudie2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 248.
    Jayakody, Maria
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Wikborg, Frida
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linneuniversitetet .
    Jämförelse av synskärpa och kontrastkänslighet för multifokala- och monofokalaintraokulära linser2022Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna litteraturstudie var att undersöka huruvida synskärpa och kontrastkänslighet skiljer sig åt mellan en monofokal intraokulär lins (IOL) och en multifokal IOL. Mätningarna som denna litteraturstudie baseras på gjordes enbart på kataraktpatienter som var över 40 år gamla.

    Metod: Genom databasen Pubmed hittades olika studier som filtrerades där enbart studier som innehöll monofokala och multifokala IOL kopplat till kontrastkänslighet samt synskärpa inkluderades. Sex studier som alla var publicerade mellan 2013 och 2022 användes för att jämföra och analysera skillnad i synskärpa och kontrastkänslighet mellan en grupp med en monofokal IOL och grupp med en multifokal IOL.Resultat: Synskärpan vid olika avstånd varierade mellan monofokala och multifokala IOL. Multifokala IOL hade bäst okorrigerad synskärpa på nära håll. Ingen signifikant skillnad mellan IOL:erna visades på synskärpan på långt håll vare sig okorrigerad eller med korrigering för avstånd. Kontrastkänsligheten var bättre med de monofokala IOL:erna i alla studier förutom en.

    Slutsats: Multifokala IOL bör vara förstahandsvalet ifall man önskar en bättre okorrigerad synskärpa på nära håll. Det är visat genom studierna att den multifokala IOL:en inte försämrar synskärpan på långt håll, däremot försämras kontrastkänsligheten.

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  • 249.
    Jeansson, Emma
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Karlsson, Rebecca
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Effekten av omega-3 på torra ögon: En litteraturstudie2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was through a literature review, investigate whether a dietary supplement of omega-3 has a positive effect on dry eye symptoms and the anterior surface of the eye. Can this polyunsaturated fatty acid relieve the symptoms and the clinical signs of dry eyes?

    The articles included in the literature study were based on previous clinical studies and scientific publications. The search engines used were PubMed and Web of Science. The searches were conducted between 2020-03-30 and 2020-04-15. Inclusion criteria and exclusion criteria were determined in advance. The restrictions were that the articles should be available in full text and be published from 2015-2020. The keywords used were “dry eye + omega” and “dry eye and omega”. Other literature reviews were excluded as well as studies with fewer than 50 participants in the randomized clinical trials (RCTs). Based on the results on the searches, 30 articles were selected that related to the topic dry eyes and omega-3. Subsequently, the articles abstracts were reviewed, and the least relevant articles were excluded. The remaining 13 articles were read in more detail and of these, the 5 most relevant articles were selected to be included in the study.

    The five selected studies involved a total of 2569 participants. The supplements used in the studies contained omega-3 in various compositions. The subjective measurements were made using the Ocular Surface Disease Index (OSDI) and the Dry Eye Questionnaire and Scoring System (DESS) and showed statistically significant improvement in symptom scores in three out of five studies. The objective clinical tests showed statistically significant improvement on for example TBUT in four out of five studies and Schirmer’s test in two out of five studies.

    The conclusion is that there is a positive effect on dry eyes, dry eye symptoms and the ocular surface of the eye with a daily supplement of omega-3 fatty acids, however a placebo effect cannot be ruled out. More studies with more participants over a longer period of time are required to determine the optimal dose, treatment period and composition of the supplement of omega-3.

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  • 250.
    Johansen, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    AI-baserad egenbehandling för patienter med ländryggsmärta: -en systematisk litteraturstudie2024Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Inledning: Ländryggsmärta är en vår tids vanligaste förekommande åkommor som drabbar cirka 70% av befolkningen och den förekommer med hög samsjuklighet och högt personligt lidande. Den genererar hög samhällelig kostnad på grund av hög sjukfrånvaro, förlorad produktivitet och höga sjukvårdskostnader och bara i Sverige beräknas den kosta 7,8 miljarder kronor. Behandlingen som har högst evidens är rehabiliteringen där patienten själv är aktiv. Med den senaste tidens digitala tekniska utveckling har vården kunnat nå ut till fler patienter och patienten själv har hamnat i centrum. Med alltmer integrering av AI-modeller i den senaste tekniken så finns det verktyg som kan individualisera behandlingen. Litteraturöversiktens syfte är att beskriva resultat, utfallsmått och kvalitet i publicerade interventionsstudier om egenbehandling med AI-teknik hos vuxna ländryggspatienter.

    Metod: Till sin design är studien en systematisk litteraturöversikt. Den är systematisk för att det finns ett metodologiskt protokoll för litteratursökningen samt en strukturerad kvalitetsgranskning av utvalda artiklar. Nyckelord har lokaliserats och tre databaser har sökts igenom. Kvalitetsgranskningen utfördes med hjälp av SBU:s mallar. Vid analysen användes en narrativ syntes som metod där resultatet extraherades från utvalda artiklar och syntetiserades till ett gemensamt resultat under respektive utfallsmått. Slutligen genomfördes en evidensgradering av den aktuella studiens resultat på respektive utfallsmått. 

    Resultat: Efter litteratursökning och urvalsprocessen lokaliserades 15 artiklar. Samtliga artiklar var kliniska interventionsstudier varav 10 av dem var RCT och övriga var enarmade kliniska studier. Artiklarna visade att AI-baserad vård hade ett förbättrande resultat för patientgruppen på smärta, funktionsnivå och psykosocialt mående. Vid utfallsmåttet smärta sågs en svag trend att det var bättre än sedvanlig vård och bland funktionsnivå sågs en mycket svag trend.  

    Diskussion: Forskningsfältet är ännu prematurt och det saknas välgjorda RCT- studier. Det saknas även standarder inom forskningsfältet kring gränsvärde för AI och det finns ett gap mellan vetenskapen kring AI och vad sjukvården faktiskt behöver i det dagliga arbetet. Modifierade implementeringsteorier inriktade speciellt mot AI behöver användas av den framtida forskningen för att bemöta gapet, och utmaningar finns kring transparens, tillit, förklarbarhet, dataskydd och etik. Slutsats: Studien ger en svag indikation på att AI- baserad egenbehandling vid ländryggsmärta är lika bra eller bättre än sedvanlig vård vad gäller förbättring av smärta hos ländryggspatienter. Studien indikerar också att funktionsnivån blir bättre med AI-baserad behandling med en mycket svag trend mot att det är bättre än sedvanlig vård. Studien visar också att det psykosociala måendet blir bättre men ej bättre en sedvanlig vård. Dock är evidensgraderingen låg till mycket låg. 

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